Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8556, Japan.
Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8556, Japan.
J Stroke Cerebrovasc Dis. 2022 Jul;31(7):106520. doi: 10.1016/j.jstrokecerebrovasdis.2022.106520. Epub 2022 May 4.
Background Selecting the appropriate direct oral anticoagulants (DOACs) for embolic ischemic stroke patients, especially on concurrent antiplatelet therapy, is important. However, a limited number of studies have reported on the pharmacological differences in platelet aggregation of each DOAC. We aimed to evaluate the antiplatelet effects of selected DOACs, by comparing dabigatran (a direct oral thrombin inhibitor) and factor Xa (FXa) inhibitors (apixaban and rivaroxaban) in patients who had suffered a cardioembolic stroke. Methods We retrospectively evaluated 12 patients diagnosed with a cardioembolic stroke who took any DOAC without an antiplatelet drug and underwent platelet aggregation tests within 60 days from the onset of symptoms. The platelet aggregation tests were analyzed by both light transmission aggregometry and VerifyNow®. Results Six patients (50%) took dabigatran, while the other six (50%) took an FXa inhibitor (n = 4 for apixaban and n = 2 for rivaroxaban). From the light transmission aggregometry analysis, it was found that the maximal extent of aggregation for adenosine diphosphate (ADP) was significantly higher with dabigatran than with FXa inhibitors, and the ED value of ADP on platelet aggregation was significantly lower with dabigatran than with FXa inhibitors. Moreover, the VerifyNow® analyses revealed that P2Y reaction units were significantly higher with dabigatran than with FXa inhibitors. Conclusions Dabigatran had little impact on platelet aggregation compared to FXa inhibitors in patients who had suffered a cardioembolic stroke with atrial fibrillation, and who took DOACs for secondary prevention within 60 days from the onset.
对于栓塞性缺血性脑卒中患者，尤其是同时接受抗血小板治疗的患者，选择合适的直接口服抗凝剂（DOAC）非常重要。然而，仅有少数研究报告了每种 DOAC 对血小板聚集的药理学差异。我们旨在评估选定的 DOAC 的抗血小板作用，比较达比加群（直接口服凝血酶抑制剂）和因子 Xa（FXa）抑制剂（阿哌沙班和利伐沙班）在患有心源性栓塞性脑卒中的患者中的作用。
我们回顾性评估了 12 例在症状发作后 60 天内未服用抗血小板药物且接受了血小板聚集试验的诊断为心源性栓塞性脑卒中的患者。通过光传输聚集仪和 VerifyNow®分析血小板聚集试验。
6 例（50%）患者服用达比加群，另 6 例（50%）患者服用 FXa 抑制剂（阿哌沙班 4 例，利伐沙班 2 例）。从光传输聚集仪分析结果来看，达比加群的二磷酸腺苷（ADP）最大聚集程度明显高于 FXa 抑制剂，ADP 对血小板聚集的 ED 值也明显低于 FXa 抑制剂。此外，VerifyNow®分析显示，达比加群的 P2Y 反应单位明显高于 FXa 抑制剂。
与 FXa 抑制剂相比，在患有房颤且在症状发作后 60 天内服用 DOAC 进行二级预防的心源性栓塞性脑卒中患者中，达比加群对血小板聚集的影响较小。
